Healthcare Provider Details

I. General information

NPI: 1275502072
Provider Name (Legal Business Name): CHRISTOPHER J FABRICANT MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/15/2006
Last Update Date: 08/03/2021
Certification Date: 08/03/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

655 SHREWSBURY AVE STE 201
SHREWSBURY NJ
07702-4151
US

IV. Provider business mailing address

655 SHREWSBURY AVE STE 201
SHREWSBURY NJ
07702-4151
US

V. Phone/Fax

Practice location:
  • Phone: 732-269-7903
  • Fax: 732-263-7905
Mailing address:
  • Phone: 732-269-7903
  • Fax: 732-263-7905

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207VG0400X
TaxonomyGynecology Physician
License NumberMA68428
License Number StateNJ
# 2
Primary TaxonomyY
Taxonomy Code207VF0040X
TaxonomyUrogynecology and Reconstructive Pelvic Surgery (Obstetrics & Gynecology) Physician
License Number25MA06842800
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: